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General NPI Number Information
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NPI Number | 1750833943
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Entity Type | Organization
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Legal Business Name | MOUNTAIN CREEK CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 707 SIGNAL MOUNTAIN RD
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City | CHATTANOOGA
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State | TN
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Zip | 37405-1823
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Country | US
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Telephone | 423-266-0900
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Fax | 423-266-0902
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Provider Business Mailing Address
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Address Line | 707 SIGNAL MOUNTAIN RD
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City | CHATTANOOGA
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State | TN
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Zip | 37405-1823
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Country | US
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Telephone | 423-266-0900
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Fax | 423-266-0902
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Authorized Official
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Title or Position | CHIROPRACTOR/PRESIDENT
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Name | DR. CHRIS CYRUL
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Credential | D.C.
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Telephone | 423-266-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1401
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License Number State | TN
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